Recreational use and misuse of nitrous oxide (N2O) have increased in recent years among young people. The objective of present study was to assess the frequency and the clinical characteristics of N2O use disorder (NUD) in a sample of health professions students. An online survey was distributed to health professions students. Age; sex; frequency (day/week/month/year/lifetime) of N2O use, DSM-5 criteria for NUD; history of mental health treatment; and current use of antidepressant medication were systematically collected. All participants completed the French version of Alcohol Use Disorders Identification Test (AUDIT), and Cannabis Abuse Screening Test (CAST). A total of 2067 students (mean age 21.7 ± 2.6 years, 74.9% female) completed the survey. A total of 38.2% (n = 790) reported lifetime N2O use. Among the 6.6% (n = 137) who fulfilled the DSM-5 criteria for current NUD, 5.5% (n = 114) had mild disorder, 0.8% (n = 16) had moderate disorder (n = 16) and 0.3% (n = 7) had severe disorder. Participants with NUD more frequently reported AUDIT scores > 12 (suggesting alcohol dependence), blackouts, a history of mental health treatment, and current use of antidepressants than did those without NUD. Longitudinal studies using structured interviews are needed to investigate potential associations between NUD and alcohol use disorders or psychiatric disorders in the general population.

BACKGROUND:Patients with bipolar disorders (BD) have significant impairments in Facial Expression Recognition (FER), an essential social skill for effective social interactions. While the Facial Emotions Recognition Test, 54 photographs by Gaudelus (TREF-54g) has been used in patients with schizophrenia, no study has evaluated FER using this test in BD patients. The TREF-54g meets the International Society for Bipolar Disorders (ISBD) criteria for assessing FER. The objective of this study was to compare FER in patients with euthymic BD versus healthy controls (HC) using the TREF-54g. METHODS:This study included 60 patients with BD diagnosed according to DSM-5 criteria, 30 with bipolar I disorder (BDI) and 30 with bipolar II disorder (BDII) and 60 HC. All groups were matched for age, gender, and years of education. Overall TREF-54g impairment score was defined as a difference of two SD from the group of HC with mean overall accuracy score expressed as a percentage of correct responses. RESULTS:Overall TREF-54g impairment scores, as well as sub-scores for anger and contempt recognition, were significantly higher in patients with BD versus those in HC. No significant differences in TREF-54g scores were shown between patients with BDI and those with BDII. LIMITATIONS:Clinical assessments of this study didn't include neurocognition assessments and classification of contempt emotion as a basic emotion remains controversial. CONCLUSIONS:We found significant impairments in FER in patients with euthymic BD, particularly for anger and contempt using the TREF-54g a test that meets ISBD recommendation criteria.

This work aimed at creating a psychosocial intervention based on growth mindset theory and implementation intention strategies, in order to reduce alcohol consumption among users in the general population, and the clinical population of individuals with alcohol use disorder. A mixed method approach was used, combining qualitative and quantitative research methods among both populations. Four focus groups were first conducted to extract arguments in favor of a malleable view of alcohol consumption (study 1A), situations that trigger the desire to drink alcohol, as well as strategies used by people to counteract this need (study 1B). Data were analyzed using reflective thematic analysis in line with the scientific literature on alcohol consumption. The results were used to create a questionnaire scoring the relevance of each argument, situation and strategy (study 2). The 20 best scored arguments, situations and strategies were selected to create the intervention. The created intervention consisted in a popularized scientific article describing alcohol consumption as malleable, including the selected arguments and followed by two internalization exercises. Then, a volitional help sheet included the selected situations and solutions was presented, allowing forming up to three plans. The discussion focused on the added value of the created material compared to pre-existing tools in the literature, and presents plans to test the intervention in a future study.

The adverse effects of smoking cessation in individuals with mental health disorders have been a point of concern, and progress in the development of treatment has been slow. The primary first-line treatments for smoking cessation are Nicotine Replacement Therapy, Bupropion, Varenicline, and behavioural support. Nortriptyline and Clonidine are second-line treatments used when the first-line treatments are not effective or are contraindicated. Smoking cessation medications have been shown to be effective in reducing nicotine cravings and withdrawal symptoms and promoting smoking cessation among patients living with mental disorders. However, these medications may have implications for patients' mental health and need to be monitored closely. The efficacy and side effects of these medications may vary depending on the patient's psychiatric condition, medication regimen, substance use, or medical comorbidities. The purpose of this review is to synthesise the pharmacokinetics, pharmacodynamics, therapeutic effects, adverse effects, and pharmacological interactions of first- and second-line smoking cessation drugs, with an emphasis on patients suffering from mental illnesses. Careful consideration of the risks and benefits of using smoking cessation medications is necessary, and treatment plans must be tailored to individual patients' needs. Monitoring symptoms and medication regimens is essential to ensure optimal treatment outcomes.

AIMS:To assess recovery of alcohol-related neuropsychological deficits in a group of patients with pure severe alcohol use disorder (AUD) during a detoxification program using the Brief Evaluation of Alcohol-Related Neuropsychological Impairment (BEARNI) test.METHODS:Thirty-two patients with severe AUD using DSM-IV criteria (24 men, mean age = 45.5 ± 6.8 years old) were assessed using the BEARNI 8 ± 2 days after alcohol cessation (T1) and then were reassessed within 18 ± 2 days after alcohol cessation (T2). The primary study endpoint was the number of patients initially impaired at T1 who recovered cognitive functions at T2 assessment.RESULTS:At T1, 59% (n = 19) patients with pure severe AUD had at least one impaired cognitive function assessed by the BEARNI. At T2, 63% of the patients with AUD with deficits at T1 had normal BEARNI cognitive scores (χ2 = 7.7, P = 0.005); specifically, the percentages of participants with normal subtest scores were 63% on memory (χ2 = 12.4, P = 0.0004), 100% on verbal fluency (χ2 = 16; P = <0.0001), 60% on alphabetical span (χ2 = 12.8; P = 0.0003) and 67% on visuospatial (χ2 = 15, P = 0.0001).CONCLUSIONS:The cognitive impairments of two-thirds of patients with pure AUD included in the present study recovered within 18 days of abstinence, earlier than reported in previous studies.

Aims: up to 80% of patients with alcohol use disorder display cognitive impairments. Some studies have suggested that alcohol-related cognitive impairments could be worsened by hepatic damage. The primary objective of this study was to compare mean scores on the Brief Evaluation of Alcohol-Related Neurocognitive Impairments measure between alcohol use disorder patients with (CIR+) or without cirrhosis (CIR-). Methods: we conducted a prospective case-control study in a hepatology department of a university hospital. All patients were assessed using the Evaluation of Alcohol-Related Neuropsychological Impairments test. Results: a total of 82 patients (50 CIR+, 32 CIR-) were included in this study. CIR- patients were significantly younger than CIR+ patients (respectively, 45.5 +/- 6.8 vs 60.1 +/- 9.0; P <.0001). After adjusting for age and educational level, the mean Evaluation of Alcohol-Related Neuropsychological Impairments total scores in the CIR+ group were significantly lower than in the group of CIR- patients (14.1 +/- 0.7 vs 7.8 +/- 0.4, respectively, P <.0001). The mean subscores on delayed verbal memory, alphabetical ordination, alternating verbal fluency, visuospatial abilities, and ataxia subtests were also significantly lower in the CIR+ than in the CIR- group (respectively, 1.9 +/- 0.2 vs 2.8 +/- 0.2; 1.8 +/- 0.2 vs 2.7 +/- 0.2; 2.2 +/- 0.2 vs 3.6 +/- 0.2; 0.7 +/- 0.2 vs 1.6 +/- 0.2; 0.7 +/- 0.2 vs 3.1 +/- 0.2; P <.0001 for all comparisons). Conclusions: in the present study, alcohol use disorder patients with cirrhosis presented more severe cognitive impairments than those without cirrhosis. Longitudinal studies are needed to investigate how cirrhosis can influence cognitive impairments.

Introduction Tianeptine is prescribed as an antidepresant in Europe. The prescription drug is produced as tianeptine sodium. However, it can also be found on the Internet as tianeptine sulfate sold as a nootropric. Misuse of tianeptine sodium has been documented, but there’s little scientific evidence of tianeptine sulfate use. Objectives Review the use of tianeptine sulfate without prescription. Present a clinical report of tianeptine sulfate use. Methods PubMed review of tienptine use without prescription. Clinical report of a patient using tianeptine sulfate adquiered on the Internet. Results Systematic review on PubMed using the search term “tianeptine abuse” conducted on 01/10/2022. A total of 71 articles were found from wich 33 mentioned the use of tianeptine use without prescription. A total of 23 case reports of tianeptine use without prescription were found. None of them made the difference between tiaenptine sodium or tianeptine sulfate. Only one article mentioned the use of tianeptine sulfate from an Internet search on Internet fora (Smith et al. Am J Drug Alcohol Abuse 2021 47(4), 455–466). The case report of a 23 years old patient is presented. Diagnoses: ADHD (F98.8); Psychotic episodes four (F23) and two (F16.150) years ago; Major depressive disorder (F32.2). Use of psychedelics, cannabis, psychoestimulants and opioids meeting substance use disorder (SUD) criteria. The patient brought proof of the tianeptine sulfate bought on the Internet (image 1) for self-treatment of his depressive symptoms. Tianeptine sodium is prescribed. The patient then restarts opioid use with fear of a new opioid use disorder episode and an oxicodone prescription is maintained. The patient then interrupts the antipsychotic medication and suffers a psychotic relapse. After this psychotic episode a LAI treatment with paliperidone is started. Currently, the patient is recovered and maintains psychopathological stability and abstinence from other substances. Blod test result unaltered. Current treatment: lisdexamphetamine 70mg /day, tianeptina sodium 12.5mg/day; oxicodone 40mg/12h and paliperidone 150mg /28d. Image: Conclusions Tianeptine sulfate is believed to present some diferences versus tianeptine sodium: it is sold only through the Internet without prescrption, the daily dose is 25mg per day versus 12.5mg every 8 hours and it might be more potent and long lasting. Those differences were confirmed by the patient after the prescription of tianeptine sodium. Self-medication with psychoactive substances is one of the theories for substance use and might lead to a substance use disorder. This case shows how the prescription of a drug similar to the one used without presription might favour the therapeutical alliance and reduce the risk associated to the use of non-regulated substances. Further research is needed to better understand the use of tianeptine sulfate. Disclosure of Interest None Declared

Introduction Cognitive impairment is a well-recognized key feature of schizophrenia. However, these cognitive impairments may be worsened by alcohol consumption. Up to 80% of patients with alcohol use disorders (AUD) display cognitive impairments. Screening for those impairments with a full neuropsychological assessment may be difficult. The Brief Evaluation Alcohol-Related Neuropsychological Impairments (BEARNI) is a specific tool for screening those impairments easy to implement in in clinical practice (Ritz et al. Alcoholism: Clinical and Experimental Research 2015; 39, 2249-60). To our knowledge, no previous studies have assessed the alcohol-related cognitive impairments using the BEARNI test in schizophrenia patients. Objectives The objective of the study was to compare BEARNI mean scores between a group of schizophrenia patients with alcohol use disorders and a group of schizophrenia patients without alcohol use disorder. Methods 39 patients with schizophrenia and AUD (SCZ/AUD +) (82% males, mean age 44.9 ± 11.0 years-old) and 49 patients with schizophrenia without AUD (SCZ/AUD-) (65% males, mean age 42.6 ± 11.4 years-old) consecutively included in the study, were assessed using the BEARNI test. All patients met DSM-5 criteria for schizophrenia and AUD. Demographic and clinical variables were also collected, using the Alcohol Use Disorders Identification Test (AUDIT) and the Positive and Negative Syndrome Scale (PANSS). The primary endpoint of the study was the difference in BEARNI cognitive mean scores between the SCZ/AUD+ and SCZ/AUD- groups. Results There was no difference between the two groups regarding demographic variables or PANSS mean scores (59.1 ± 12.8 vs 58.1 ± 14.0; t=-0.3; p=0.7). The AUDIT mean score was higher in the group of patients SCZ/AUD+ (20.6 ± 7.8 vs 1.6 ± 1.5; t=-14.7; p<0.0001). Total BEARNI and cognitive BEARNI mean scores were significantly lower in the group of patients SCZ/AUD+ compared to the group of patients SCZ/AUD- (10.6 ± 4.8 vs 12.6 ± 5.2; t=1.8, p=0.03 and 8.1 ± 3.9 vs 9.8 ± 3.6 t=2.0, p=0.04, respectively). The mean subscores of delayed verbal memory, alphabetical ordination, and alternating verbal fluency subtests were also significantly lower in the group of patients SCZ/+ group (respectively 1,0 ± 0.9 vs 1.6 ± 1.2, t= 2.5, p=0.01; 2,1 ± 1.2 vs 2.5 ± 1.1, t= 1.6, p=0.04; 3.3 ±1.5 vs 3.8 ± 1.5, t= 1.8, p=0.03). Conclusions The present study found cognitive impairments using BEARNI test in schizophrenia patients with AUD compared to their counterparts without AUD. Screening alcohol related cognitive impairments using BEARNI could be easier in patients in schizophrenia patients with AUD than usual neurocognitive assessments Disclosure of Interest None Declared

Introduction Nitrous oxide recreational use and abuse has significantly increased in recent years among youth. To our knowledge, no previous study investigated the frequency and characteristics of N2O use disorder. Objectives To assess the frequency and the socio-demographic and clinical characteristics of nitrous oxide use disorder in a sample of health professions students. Methods An online survey was distributed to health professions students at Paris-Cité University, Paris-Sorbonne University, Paris-Saclay University, Lille University and Picardy University, France. The following data were collected: age, gender, frequency of nitrous oxid use, DSM-5 criteria for nitrous oxide use disorder, frequency (day/week/month/year/lifetime) of tobacco, alcohol, cannabis, cocaine, amphetamines, and hallucinogens use, Alcohol Use Disorders Identification Test scores (AUDIT), the Fagerström Tobacco Dependence Test scores, the Cannabis Abuse Screening Test scores, lifetime psychiatric or sleep disorders. Results 2067 participants (mean age 21.7±2.6 years, 75% female) completed the survey from September 2021 to May 2022. Among them, 38% (n=790) reported nitrous oxide lifetime use. Seven per cent of the subjects (n=137) fulfilled DSM-5 criteria for current nitrous oxide use disorder (114 mild use disorder, 16 moderate use disorder, 7 severe use disorder). In the group of patients with nitrous oxide use disorder, there were correlations between nitrous oxide use disorder and daily alcohol use (Chi2=24.2, p<0.0001), daily tobacco use (Chi2=25.3, p<0.0001), AUDIT scores >12 (Chi2=7.9, p<0.0001), lifetime depressive disorders (Chi2 =13.6, p=0.0001), anxiety disorders (Chi2 =13.2, p=0.02), or sleep disorders (Chi2 =14.4, p=0.006), compared to the group of subjects without nitrous oxide use or the group of subjects without nitrous oxide use disorders. Conclusions Nitrous oxide use and nitrous oxide use disorder were common among the health professions students included in the present study and correlated with daily alcohol or tobacco use. Disclosure of Interest None Declared

This case report highlights the case of a woman from Senegal with PICA disorders switching from kaolin a substance commonly used in african woman population, to paper PICA in the context of anxiety disorder.

Background: The aim of the present study was to assess the frequency and clinical correlates of users of an Internet drug forum who changed their alcohol use during the March–May 2020 COVID-19 lockdown in France. Methods: An anonymous Internet-based cross-sectional survey during the COVID-19 lockdown was used via messages on a French Internet drug forum. Participants reported any increase in their alcohol consumption during the lockdown. Alcohol craving and depressive/anxiety symptoms were assessed using the Obsessive and Compulsive Drinking scale (OCDS) and Hospital Anxiety and Depression scale (HADS). Results: Of 1310 respondents, 974 (79% of 1270) participants reported alcohol use before lockdown. During the lockdown, 405 participants (41.6%; IC95 (38.5–44.7)) reported an increase. Odds of an increase in alcohol consumption was higher for those with HADS scores higher than 7 (aOR: 2.19; p = 0.00002), OCDS scores greater than 7 (aOR: 3.50; p < 0.001), and daily psychostimulant use (aOR: 1.85; p = 0.002). Conclusions: Users of an Internet drug forum who reported high levels of depressive symptoms, high levels of alcohol craving, and the use of psychostimulants were more likely to increase alcohol consumption during a COVID-19 lockdown.

Évaluer l’intérêt pour l’application MyDéfi comme outil d’aide au repérage et à la prise en charge de la consommation excessive d’alcool par des pharmaciens d’officine, ainsi que leur perception et connaissances sur l’alcool et leur rôle possible pour sa prise en charge. Étude prospective mixte, qualitative et quantitative, reposant sur des entretiens semi-directifs en face-à-face. Les 101 pharmaciens de la région des Hauts-de-France interrogés considèrent que le repérage de la consommation d’alcool fait partie de leurs missions, même si c’est un sujet difficile et qu’ils ont reçu une formation spécifique en alcoologie durant leurs études. Seuls 12 % ont connaissance du repérage précoce et de l’intervention brève sur l’alcool. Plusieurs obstacles sont évoqués comme le manque de formation et de confidentialité, les difficultés liées aux particularités des patients. Au total, 41 % déclarent que l’officine n’est pas adaptée et près de 72 % que l’application MyDéfi pourrait leur être utile pour réaliser un dépistage, et 91 % seraient prêts à recommander l’application, car c’est un des meilleurs supports, facile à conseiller avec un suivi personnalisé. Pour 32 %, l’application est accessible aux patients (40 % pensent que le principal inconvénient de l’application est l’inaccessibilité et 27 % son coût). Les pharmaciens considèrent que le la consommation excessive d’alcool est un problème majeur qui doit les mobiliser, mais ils sont nombreux à ne pas se sentir prêts à proposer des interventions brèves. Après avoir vu comment fonctionnait l’application MyDéfi, la majorité a considéré qu’elle pourrait les aider dans leur mission de prévention. Evaluate the interest in the MyDéfi application as a tool to help pharmacists identify and manage excessive alcohol consumption, as well as their perception and knowledge of alcohol and their possible role in its management. Prospective mixed qualitative and quantitative study, based on face-to-face semi-directive interviews. The 101 pharmacists interviewed in Hauts-de-France region considered that the detection of alcohol consumption was part of their mission, even if it is a difficult subject, and that they had received specific training in alcohology during their university training. Only 12% were aware of early screening and brief intervention on alcohol. Several obstacles were mentioned, such as the lack of training and confidentiality, and difficulties related to patient specificities. Forty-one percent said that the pharmacy was not suitable and almost 72% said that the MyDéfi application could be useful for screening and 91% would recommend the application as one of the best supports, easy to advise with a personalised follow-up. For 32%, the application is accessible to patients (40% think that the main drawback of the application is inaccessibility and 27% its cost). Pharmacists consider that excessive alcohol use is a major problem that should mobilise them but many do not feel ready to offer brief interventions. After seeing how the MyDéfi application worked, the majority considered that it could help them in their prevention mission.

Objective: Drinking motives are considered to be major predictors of alcohol consumption and alcohol-related problems. However, these motives have been poorly investigated in patients with schizophrenia. The aim of the present study among patients with schizophrenia was twofold: 1) assess the validity of the short form of the Drinking Motives Questionnaire-Revised (DMQ-R SF); and 2) investigate the relationship between drinking motives and comorbid alcohol use disorder (AUD). Method: A total of 179 patients with schizophrenia were approached to participate in the study. DSM-5 criteria were used to identify patients with comorbid AUD (AUD+; n = 42) and non-abstainers patients without comorbid AUD (AUD-; n = 71). Results: A confirmatory factor analysis conducted on items of the DMQ-R SF for the whole sample revealed adequate goodness-of-fit values, while internal consistency indices were globally satisfactory. Group comparisons revealed higher use of alcohol and other substances, as well as stronger drinking motives among AUD + patients, while groups were comparable concerning clinical features of schizophrenia, including psychotic symptom dimensions and severity. Regression analysis showed that the Alcohol Use Disorder Identification Test score was significantly associated with two internal drinking motives: enhancement and coping. Conclusions: Findings suggest that the DMQ-R SF is a reliable tool for assessing drinking motives among patients with schizophrenia. Enhancement and coping motives seem to play a major role in comorbid AUD among these patients. Community-based and clinical treatment programs should take the drinking motives of dual-diagnosis patients into consideration, in order to improve their outcomes.

Objectives. - Evaluate the interest in the MyDefi application as a tool to help pharmacists identify and manage excessive alcohol consumption, as well as their perception and knowledge of alcohol and their possible role in its management.Methods. - Prospective mixed qualitative and quantitative study, based on face-to-face semi-directive interviews.Results. - The 101 pharmacists interviewed in Hauts-de-France region considered that the detection of alcohol consumption was part of their mission, even if it is a difficult subject, and that they had received specific training in alcohology during their university training. Only 12% were aware of early screening and brief intervention on alcohol. Several obstacles were mentioned, such as the lack of training and confidentiality, and difficulties related to patient specificities. Forty-one percent said that the pharmacy was not suitable and almost 72% said that the MyDefi application could be useful for screening and 91% would recommend the appli-cation as one of the best supports, easy to advise with a personalised follow-up. For 32%, the application is accessible to patients (40% think that the main drawback of the application is inaccessibility and 27% its cost).Conclusion. - Pharmacists consider that excessive alcohol use is a major problem that should mobilise them but many do not feel ready to offer brief interventions. After seeing how the MyDefi application worked, the majority considered that it could help them in their prevention mission.(c) 2022 Acad acute accent emie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.

BACKGROUND AND OBJECTIVE:To describe the clinical characteristics and the outcomes of a group of elderly patients referred to a liaison psychiatry department in the emergency department of an Academic University Hospital.METHODS:A group of 39 patients aged over 65 years (mean age: 70. years, 56% male), consecutively referred to a liaison psychiatry department between March 2017 and December 2020, was compared to a group of 613 patients aged under 65 years (mean age: 42.0 years, 69% male) following their admission to the emergency department of the Amiens University Hospital, France.RESULTS AND CONCLUSIONS:The main reasons for admission in the emergency department were alcohol intoxication (54%), depressive symptoms (23%), and suicidal ideas or behaviors (24%), without significant difference with the group of patients aged under 65 years of age. The rate of patients smoking tobacco on a daily basis was lower in the group of patients over 65 years of age (respectively 28% versus 71%, P < 0.0001). The rates of patients who used alcohol on a daily basis, patients with current depressive disorders, patients with personality disorders, patients receiving antidepressants, benzodiazepines or hypnotic treatments were similar in both groups. The prescription of pharmacological treatments for smoking cessation and for alcohol cessation should be enhanced.